MON-182 - False Positive Hysterosalpingography Rates Among PCOS Patients and Patients of Different Parity

Background
Impaired tubal patency is implicated in up to 35% of female sub-fertility and infertility cases. Hysterosalpingography (HSG) is a commonly used method to determine tubal patency and guide a diagnosis of infertility. HSG result accuracy is important, as false positives can lead to unnecessary procedures such as fallopian tube recanalization (FTR), as well as unnecessary stress or false hope for the patient.

Method
A single center retrospective analysis review of all patients that underwent initial HSG (iHSG) with either the diagnostic radiology (DR) or the obstetrics and gynecology (OB) departments followed by FTR at the author’s institution from 1/1/2020 through 1/1/2025. Data reviewed included demographics, pregnancy related information, comorbidities, procedure details, radiologic and clinical outcomes. An iHSG study was defined as positive when tubal occlusion (uni or bilateral) was visualized and confirmed on subsequent FTR, and false positive (FP) when the iHSG was positive, but the subsequent HSG at the time of FTR (sHSG) demonstrated bilateral tubal patency without any intervention. An iHSG study was defined as negative when both tubes were visualized as patent with contrast spillage in the pelvis, and hence patients were not referred for FTR. Student Chi-squared test and Fisher’s test were used for categorical variables. P values less than 0.05 were considered statistically significant.

Results
126 patients underwent iHSG during the study period with a diagnosis of uni- or bilateral tubal occlusion. All patients were referred for FTR. Mean age was 33.6 years (range 21-46 years) and BMI 33.8 (range 19.2-67.3). 22 (17.5%) patients had a diagnosis of PCOS, 70 (55.6%) patients were nulliparous, 33 (26.2%) primiparous and 17 (13.5%) multiparous. 6 (4.8%) patients did not have parity data available. None of the patients undergoing iHSG received sedation, while 100% of sHSG procedures were performed with moderate sedation administered by the performing interventional radiologist. The overall FP rate of the iHSG was 48.4% (61/126 patients). 10 (7.9%) iHSG were performed by DR and 116 (92.1%) by OB with similar FP rates (60% and 47.4%, respectively, p=0.521). PCOS patients had an iHSG FP rate of 59.1%, while patients without PCOS had an iHSG FP rate of 46.2% (p=0.349). Nulliparous patients had an iHSG FP rate of 48.6%, primiparous 60.6% and multiparous 23.5%, respectively (p=0.223).

Conclusion
No statistically significant differences were observed among groups. However, primiparous patients demonstrated a trend toward a higher frequency of FP iHSG, followed by nulliparous patients. This may reflect tubal spasm or insufficient pressurization of the uterine cavity at the time of the iHSG, potentially related to pain in the absence of sedation. These factors can lead to unnecessary workup and should be discussed with the patient during pre-procedural counseling.

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